Spinal anesthesia is safe in laparoscopic total extraperitoneal inguinal hernia repair. A retrospective clinical trial.

Abstract

IntroductionLaparoscopic total extraperitoneal (TEP) inguinal hernia repair is an effective and safe method for the treatment of inguinal hernia. There are very few studies on regional anesthesia methods in TEP surgery.AimTo compare TEP inguinal hernia repair performed when the patient was treated under spinal anesthesia (SA) with that performed under general anesthesia (GA).Material and methodsAll total of 80 patients were studied between December 2015 and March 2017. Hyperbaric bupivacaine and fentanyl were used for SA, to achieve a sensorial level of T3. Propofol, sevoflurane, rocuronium, fentanyl, and tracheal intubation were used for GA. Intraoperative events related to SA, surgical times, intra- and postoperative complications, and pain scores were recorded.ResultsThe mean operative time in the SA TEP group was 70.2 ±6.7 min, which was significantly longer than the mean operative time in the GA TEP group of 67.2 ±6.2 min (p < 0.038). The mean pain scores in the SA TEP group were 0.23 ±0.42 at the first hour, 1.83 ±0.64 at 6 h and 1.28 ±0.45 at 24 h. These scores were significantly lower than the corresponding scores of 5.18 ±0.84 (p < 0.001), 2.50 ±0.55 (p < 0.001) and 1.58 ±0.55 in the GA TEP group. Generally, patients were more satisfied with SA than GA (p < 0.004).ConclusionsSpinal anesthesia TEP is significantly less painful in the early postoperative period, leading to earlier ambulation than GA TEP. Additionally, SA TEP results in significantly less need for analgesics and better patient satisfaction results. SA TEP seems to be a better alternative than the existing GA TEP.

Totally extraperitoneal inguinal hernia repair with or without fixation leads to similar results. Outcome of randomized prospective trial.

“…With hernia removal the pain subsides or is markedly reduced, as is pain-related physical restriction. Our results are confirmed in the reports of other authors where TEP-IHR is also given a high rating [11,13,16,17].…”

“…Therefore, it is believed to be easier to use, thus reducing the time of surgery. On the other hand, the anatomical shape better fits the tissues and minimizes the need for mesh fixation [11]. In our study we report two hernia recurrences (1.43%) which is an acceptable rate comparable to that reported in other literature data [18], although there are also reports of no recurrences whatsoever [21,27].…”

“…We are aware that our study groups are relatively small and our results need confirmation in larger cohorts, but we did not observe any marked unfavorable effect of implant fixation or benefits from the use of the Parietex Pro-Grip self-fixing mesh. Our observations regarding the ProGrip self-fixing mesh are not confirmed in the studies of other authors, who demonstrated its beneficial treatment effect mostly reflected in the reduction of post-operative pain, faster return to normal physical activity or lack of hernia recurrence [11,22,23,30,31]. Most of the studies have shown that non-fixation hernia repair is generally more cost-effective than repair with mesh fixation.…”

“…Thus, our results do not confirm the adverse effect of fixation on the risk of chronic pain, which is in accordance with results of similar studies and meta-analyses [6,[16][17][18][19][20]. On the other hand, the outcome of our study is contradictory to the study results of some other authors [9][10][11]21]. During 1 year follow-up we found no statistically significant differences between study groups with regard to intensity of acute pain or demand for pain killers in the early post-operative period and later.…”

“…tacks, may prove to be a disadvantageous factor that increases the risk of damage to anatomical structures and the occurrence of chronic pain. Thus, the use of atraumatic alternatives such as self-gripping meshes or fibrin glue may contribute to lower postoperative pain [3,[6][7][8][9][10][11][12].…”